Metformin
Metformin (Glucophage)
Clinical Summary
Metformin is a first-line oral antihyperglycemic agent for type 2 diabetes. Documented on handwritten prescription as "Glulucamio" — likely brand name or misspelling of Glucophage (metformin).
Newly documented from handwritten prescription dated 2026-05-04. Dose: 500 mg three times daily (1-1-1 dosing with meals).
Dosing History
| Date | Dose | Frequency | Route | Context |
|---|---|---|---|---|
| 2022-11-25 | 500 mg | BID (morning & night) | Oral | "Glycomet XL" extended-release formulation — total 1000 mg/day |
| Between 2022–2026 | 500 mg | Escalated to TID (1-1-1) | Oral | Dose escalated at unknown date — total 1500 mg/day |
| 2026-05-04 | 500 mg | Three times daily (1-1-1) | Oral | Documented from handwritten Rx ("Glulucamio") |
[!info] Dose Escalation Documented: 1000 mg/day → 1500 mg/day
November 2022: Glycomet XL 500 mg BID (extended-release, 1000 mg/day)
May 2026: Glulucamio 500 mg TID (1500 mg/day)
The dose was escalated by 50%, likely due to inadequate glycemic control. The formulation also changed from extended-release (XL) to regular (or different brand).
Total daily dose as of 2026: 1500 mg/day (divided dosing).
Indication
Type 2 Diabetes Mellitus. First-line agent for glycemic control. Reduces hepatic glucose production, decreases intestinal glucose absorption, improves insulin sensitivity.
Pharmacology
- Drug class: Biguanide antihyperglycemic
- Mechanism: Decreases hepatic gluconeogenesis, decreases intestinal glucose absorption, improves peripheral glucose uptake and utilization
- Half-life: ~6.2 hours
- Excretion: Renal (unchanged)
- Standard dose: 500 mg–2000 mg daily in divided doses (current: 1500 mg/day)
Monitoring — CRITICAL in AML/CKD Setting
| Parameter | Frequency | Rationale | Ishamma Status |
|---|---|---|---|
| Renal function (creatinine, eGFR) | Baseline, then every 3–6 months | Metformin contraindicated if eGFR <30; use caution if eGFR 30–45 | Creatinine stable 0.7–0.9 mg/dL (normal) |
| Lactic acid | If symptoms develop | Lactic acidosis is rare but life-threatening adverse effect | Not yet documented |
| Vitamin B12 | Annually | Metformin can cause B12 malabsorption | Not yet documented |
| Fructosamine/glucose | Ongoing | Glycemic control monitoring | Fructosamine 310 (HIGH, Apr 2026) |
Metformin is renally excreted. While Ishamma's creatinine is currently normal (0.7–0.9 mg/dL), AML treatment and age increase risk of renal decline. eGFR should be calculated and monitored. Metformin should be discontinued if eGFR falls below 30 mL/min/1.73m².
[!info] Hold Metformin During Acute Illness
Standard practice: hold metformin during acute illness, dehydration, sepsis, or contrast dye procedures (lactic acidosis risk). Resume when stable.
Drug Interactions
- Contrast dye (iodinated): Hold metformin before and 48 hours after contrast procedures; resume only after confirming normal renal function
- Carbonic anhydrase inhibitors (acetazolamide, topiramate): Increased lactic acidosis risk
- Alcohol: Increased lactic acidosis risk
- No CYP450 interaction with posaconazole/venetoclax
Adverse Effects
- GI effects (most common): Nausea, diarrhea, abdominal discomfort, metallic taste — usually transient, improve with food and gradual dose titration
- Lactic acidosis (rare but serious): Risk factors: renal impairment, hepatic impairment, sepsis, dehydration, acute CHF, hypoxia
- Vitamin B12 deficiency: Long-term use can impair B12 absorption
- Does NOT cause hypoglycemia when used alone
Contraindications
- eGFR <30 mL/min/1.73m²
- Acute metabolic acidosis
- Severe hepatic impairment
- Acute CHF requiring pharmacologic treatment
- Sepsis, hypoxia, dehydration
Related
- Diabetes Mellitus — Primary indication
- Linagliptin — Co-administered DPP-4 inhibitor
- Insulin Degludec — Co-administered basal insulin
- Creatinine — Monitor renal function
- Fructosamine — Preferred glycemic marker in AML setting
Medication page created during ingest of 2026-05-04 handwritten prescription.